By Trent Corey, PT, DPT New Heights Physical Therapy Plus, Vancouver, WA
In the line of work that I do, I am very fortunate to be able to treat people who have a variety of physical ailments, ranging from ankle sprains and lower back pain to cervical whiplash. Though all of my patients bring a set of challenges, there is something very different about the runners that I treat. As I myself have been a runner for over 20 years, with much of that time spent injured, I know how hard it is when an injury prevents me from getting out on the trail or roads.
It is estimated that 82% of all runners suffer injuries during their running career. Though I don’t claim to know everything about the subject of running injuries and mechanics, I certainly know enough to help most of my runners get back to full capacity. Here are a few “take home” tips that if each injured runner actually listened to and followed, would significantly reduce the number of commonly occurring running injuries.
Pay attention to what got you injured.
This may sound elementary, but some runners actually have no idea what they did that brought them to my clinic. Usually it’s due to a “Training Error”, a term that basically means too much too soon: Ramping up speed, distance, or both at a rate their body was unable to handle.
Back off the running for a little while.
Focus more on your imbalances, muscle weakness and tightness instead of plugging along on the same old run. I frequently see people continue to run the same distance and pace, wondering why they aren’t getting any better. Now, if you do not hurt during or after your run, or things are not getting worse with longer runs, then fine, you are on the right path. However, there is an element of addiction in running (and other endurance sports) that is unlike anything I’ve seen with other injuries. Runners need their fix, and no matter how often I tell them to slow down or cut back, they keep coming back for more of the very thing that injured them in the first place. A physical therapy evaluation will identify patterns to work on; the key is to replace the old habits with new ones that make you stronger and more aligned as a runner, so you will be able to run for the months and years ahead. Isn’t that worth a brief decrease in mileage in the short term?
Get your hips and butt working for you.
I would say that about 90% of the runners I treat have weakness and/or tightness in the hips (usually both). This compromises your ability to stand on one leg as you transfer your weight forward during gait. There is a great article about this in the April 2014 issue of Running Times magazine. I have an awesome routine that I give to patients that will get those butt muscles firing, as well as get all major muscle groups lengthened such as hip flexors, gluteals, adductors, quads, and hamstrings.
Do your core work.
I don’t care if it’s Pilates, Yoga, planks, or P90X, this is a crucial part of stability in gait. If you are weak in your core, then you set yourself up for a whole host of problems throughout your system. We need to start thinking of ourselves as athletes, not just sedentary people who run. My runners get a healthy serving of core stability exercises that start from the most basic “neutral spine” positions to more dynamic stability movements on the ball, foam roller, or other unstable surfaces.
Get better at standing on one foot.
I heard once from an online running coach that all runners should be able to stand on one leg for at least 3 minutes. Try it. It’s hard to do if your feet and hips are not strong. Also, it’s amazing how bad people’s awareness of their bodies are, especially the injured ones. Practice single leg balance for at least 2 minutes while brushing your teeth is a great way to improve body awareness and alignment for running.
Check yourself out on video.
This doesn’t have to be complicated, and since having a video camera is so common, it’s very easy to capture. All you need is about 30 seconds (or less) of running at normal pace viewed from the side and from the back. Even without training in biomechanics, you are usually able to see things about your stride that don’t look quite right. By doing the exercises and body focuses that we work on in therapy, you can recheck your form again in a month or so to see if you notice a difference. Of course, we also do some basic video analysis in the clinic using an iPad so you can see what we see in your stride and what needs work. A good article about this was written in the Jan/Feb 2011 issue of Running Times.
Feel the Chi:
I highly recommend the book Chi Running, by Danny Dreyer. Its simple approach to running stride is less about force and more about flow. The basics include posture focuses such as leveling your pelvis, then leaning yourself forward while picking your feet quickly off the ground, not pressing. The stride rate, or number of strides per minute is usually more than you’re used to, but it helps take pressure off the muscles and joints, since you are using gravity to pull you into a controlled fall forward. These are just the basic concepts, but it can help you run further with much less effort. Chi Running also has an App on iPhone that you can use to get your mind around this new concept.
Runners who develop chronic tendonitis (now officially classified as a tendonosis), may benefit from a type of therapy called ASTYM. Tendonosis is the break down in connective tissue strength and elasticity due to repetitive loading and inflammation cycles. ASTYM uses special instruments to help stimulate growth factors in chronically inflamed and scarred down tissues, helping to remodel new tissue growth that will be stronger once healed. What’s great about ASTYM to runners is that it is important to exercise regularly to load the tissue, because this helps your body to stimulate a new stronger tendon or muscle.
Work out your tissue yourself.
ASTYM can be painful, but very effective, and so is massage if you can afford to go regularly. Another tool to become familiar with and use frequently is a foam roller. In general, the more sensitive an area is, such as your calf or butt muscle, the more you need to massage it.
Persistence, persistence, persistence!!!!
One of my greatest challenges as a physical therapist is managing patients’ expectations about recovering from an injury. When patients come back after a week or two, or even at the second visit, and wonder why they aren’t any better, I usually remind them that this problem has been brewing for quite a while so a couple of quick exercises will not be enough to snap them right into perfect running form with no more injuries. There are important things that must be done in therapy, and it takes up to 6000 repetitions of any movement for it to become ingrained as a habit without conscious focus. Keep in mind the three goals of therapy: To improve muscle strength and flexibility, develop balance in the right places, and most importantly, train your nervous system to work correctly by feeling the optimal way to put one foot in front of the other. This is like running to the horizon—you may never get to the ideal, but keep working at it by tuning into your body. Your body will be glad you put the effort in to gain healthy new habits to keep you running for a long time.
Anatomy for Runners, by Jay Dicharry, MPT
The Runner’s Guide to Yoga, by Sage Rountree